STARRT-AKI (secondary analysis, accelerated RRT)
Trial question
What is the effect of accelerated RRT initiation in patients with pre-hospital measures of kidney function?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
31.0% female
69.0% male
N = 1121
1121 patients (353 female, 768 male)
Inclusion criteria: patients with documented pre-existing eGFR data prior to hospitalization
Key exclusion criteria: eGFR < 20 mL/min/1.73 m²
Interventions
N=561 accelerated strategy (initiation of RRT within 12 hours)
N=560 standard strategy (RRT initiation discouraged until development of conventional indications or persistent AKI for ≥ 72 hours)
Primary outcome
Death in patients with chronic kidney disease at day 90
47
47.4
47.4 %
35.5 %
23.7 %
11.8 %
0.0 %
Accelerated
strategy
Standard
strategy
No significant
difference ↔
No significant difference in death in patients with CKD at day 90 (47% vs. 47.4%; OR 0.98, 95% CI 0.67 to 1.44)
Secondary outcomes
No significant difference in death in patients without CKD at day 90 (40.9% vs. 38%; OR 1.13, 95% CI 0.83 to 1.53)
Borderline significant increase in RRT dependence in patients with CKD at day 90 (19.8% vs. 7.2%; OR 3.18, 95% CI 1.41 to 7.91)
No significant difference in RRT dependence in patients without CKD at day 90 (6.5% vs. 8.9%; OR 0.71, 95% CI 0.34 to 1.47)
Conclusion
In patients with documented pre-existing eGFR data prior to hospitalization, accelerated strategy was not superior to standard strategy with respect to death in patients with CKD at day 90.
Reference
Sean M Bagshaw, Ary Serpa Neto, Orla Smith et al. Impact of renal-replacement therapy strategies on outcomes for patients with chronic kidney disease: a secondary analysis of the STARRT-AKI trial. Intensive Care Med. 2022 Dec;48(12):1736-1750.
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